What is the best suture material for a facial wound?

Best Suture for Facial Wounds

For facial wound closure, use monofilament absorbable sutures (5-0 poliglecaprone-25 or 5-0 rapidly absorbing polyglactin 910) with a continuous non-locking subcuticular technique, as they provide equivalent cosmetic outcomes to non-absorbable sutures while eliminating the need for suture removal. 1, 2, 3

Optimal Suture Material Selection

Monofilament Absorbable Sutures Are Preferred

• Monofilament sutures cause less bacterial seeding and reduce infection risk compared to multifilament options, making them the material of choice for facial wounds 1, 4
• 5-0 poliglecaprone-25 (Monocryl) provides cosmetic results equivalent to 6-0 polypropylene (non-absorbable) in facial closures, with no statistically significant difference at 4-month follow-up (85% showed no difference between materials) 3
• 5-0 rapidly absorbing polyglactin 910 (Vicryl Rapide) demonstrates equivalent photographic scar appearance compared to 5-0 nylon at 6 months post-surgery, with no significant difference in visual analog scale scores (83.1 vs 83.0, P=0.72) 5

Specific Material Recommendations

• Use 5-0 poliglecaprone-25 (Monocryl) or 5-0 rapidly absorbing polyglactin 910 (Vicryl Rapide) for epidermal closure 1, 2, 3
• These absorbable options eliminate suture removal, saving time and reducing patient anxiety and discomfort 1, 2
• For deep dermal layers, use 4-0 poliglecaprone-25 to provide structural support 2

Materials to Avoid

• Never use catgut sutures for facial wounds, as they are associated with more pain and higher risk of requiring resuturing 1, 6
• Multifilament sutures should be avoided due to increased bacterial seeding risk 1

Suturing Technique

Continuous Non-Locking Subcuticular Closure

• Use continuous non-locking subcuticular technique for the final epidermal layer to minimize scarring and distribute tension evenly 1, 6, 4
• This technique avoids damage to superficial nerve endings, reducing postoperative pain 4
• Never use locking sutures, as they cause excessive tension leading to tissue edema and necrosis 6, 4

Suture Placement Specifications

• Place sutures approximately 5mm from the wound edge and between stitches to ensure adequate tension distribution without tissue strangulation 7, 6
• Use 4-0 or 5-0 suture size for optimal wound closure in facial lacerations 1, 6
• Avoid overly tight sutures that can strangulate tissue and impair healing 4

Antimicrobial-Coated Sutures

Consider Triclosan-Coated Options When Available

• Triclosan-coated sutures (such as Vicryl Plus) significantly reduce surgical site infection rates compared to non-coated sutures (OR 0.72,95% CI 0.59-0.88, P=0.001) 7
• Use antimicrobial-coated sutures for facial wounds in clean-contaminated or contaminated fields when available 7, 4
• The infection reduction benefit is consistent across different wound types and surgical procedures 7

Clinical Outcomes and Evidence Quality

Equivalent Cosmetic Results

• High-quality randomized trials demonstrate no difference in long-term cosmetic outcomes between absorbable and non-absorbable sutures for facial wounds 2, 3, 5
• No wound infections or premature suture rupture occurred in comparative studies of facial closures 2
• Patient satisfaction and observer assessments show comparable results between material types 5

Practical Advantages of Absorbable Sutures

• Elimination of suture removal saves surgeon time and decreases patient anxiety 1, 2
• Cost-effective when using remaining absorbable suture from deep layer closure 3
• Minimal pain during natural absorption process compared to removal procedures 8

Common Pitfalls to Avoid

• Do not assume non-absorbable sutures provide superior cosmetic outcomes—evidence shows equivalence with properly selected absorbable materials 2, 3, 5
• Avoid using adhesive steri-strips routinely, as they provide no additional benefit in cosmetic outcomes or scar width reduction 7
• Do not use tissue adhesives alone for facial wounds, as sutures are significantly better at minimizing wound dehiscence (RR 3.35,95% CI 1.53-7.33) 7